Predictors of Poor Functional Status in Adult Fontan Patients Living at Moderate Altitude
Abstract Patients who have undergone Fontan palliation have reduced exercise tolerance measured by maximal oxygen consumption ($ VO_{2} $ max). Declining exercise capacity is associated with increased morbidity and mortality. The impact of hemodynamics and other variables on this population’s functional status is not well understood. This study sought to identify variables that predict low $ VO_{2} $ max in Fontan patients living at moderate altitude (5,000–8,000 feet). We performed a retrospective cohort study of 44 adult Fontan patients living at moderate altitude who had undergone cardiopulmonary exercise testing (CPET) and cardiac catheterization. We evaluated hemodynamic parameters measured during catheterization, imaging results, and laboratory studies for correlation with $ VO_{2} $ max measured during CPET. Our study cohort (median age 30 years, 52% female) had exercise impairment with mean $ VO_{2} $ max of 21.6 mL/kg/min. Higher trans-pulmonary gradient (TPG) (p < 0.001) and mean pulmonary artery (PA) pressure (p = 0.013) were predictors of lower maximal and submaximal $ VO_{2} $. Higher BNP values correlated with lower $ VO_{2} $ max (p = 0.01). Platelet count, GGT, albumin, and pulmonary vasodilator therapy did not correlate with $ VO_{2} $ max. None of the studied variables were associated with higher minute ventilation to peak carbon dioxide production (VE/$ VCO_{2} $ slope) or change in $ VO_{2} $ max over time. In conclusion, higher TPG and mean PA pressure predicted lower exercise tolerance amongst our cohort of adult Fontan patients living at moderate altitude. Future studies are needed to determine if these clinical variables represent viable therapeutic targets that could result in improved exercise tolerance and outcomes in patients with Fontan circulation..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
Pediatric cardiology - 42(2021), 8 vom: 18. Juni, Seite 1757-1765 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Stevens, CG. [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Altitude |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021 |
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| doi: |
10.1007/s00246-021-02660-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a Abstract Patients who have undergone Fontan palliation have reduced exercise tolerance measured by maximal oxygen consumption ($ VO_{2} $ max). Declining exercise capacity is associated with increased morbidity and mortality. The impact of hemodynamics and other variables on this population’s functional status is not well understood. This study sought to identify variables that predict low $ VO_{2} $ max in Fontan patients living at moderate altitude (5,000–8,000 feet). We performed a retrospective cohort study of 44 adult Fontan patients living at moderate altitude who had undergone cardiopulmonary exercise testing (CPET) and cardiac catheterization. We evaluated hemodynamic parameters measured during catheterization, imaging results, and laboratory studies for correlation with $ VO_{2} $ max measured during CPET. Our study cohort (median age 30 years, 52% female) had exercise impairment with mean $ VO_{2} $ max of 21.6 mL/kg/min. Higher trans-pulmonary gradient (TPG) (p < 0.001) and mean pulmonary artery (PA) pressure (p = 0.013) were predictors of lower maximal and submaximal $ VO_{2} $. Higher BNP values correlated with lower $ VO_{2} $ max (p = 0.01). Platelet count, GGT, albumin, and pulmonary vasodilator therapy did not correlate with $ VO_{2} $ max. None of the studied variables were associated with higher minute ventilation to peak carbon dioxide production (VE/$ VCO_{2} $ slope) or change in $ VO_{2} $ max over time. In conclusion, higher TPG and mean PA pressure predicted lower exercise tolerance amongst our cohort of adult Fontan patients living at moderate altitude. Future studies are needed to determine if these clinical variables represent viable therapeutic targets that could result in improved exercise tolerance and outcomes in patients with Fontan circulation. | ||
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